Evaluating the Diagnostic Validity of the Ankle-Brachial Index in Diabetic Populations: A Methodological Deconstruction of Pseudo-normality and Its Impact on Health Professional Decision-Making Using a Target Trial Emulation Framework

Aiden Yi-Fei Wang, Xiu-Wen Ling, Amber Haseeb, Atiqah Aziz, Han-Ling Tan, Terry Hao-Yu Qin, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning , Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Applied Statistics Program, Department of Decision Science, Faculty of Business and Economics, Universiti Malaya, Kuala Lumpur, Department of Orthopaedic Surgery, Faculty of Medicine, University Malaya Medical Centre , Kuala Lumpur, Department of Orthopaedic Surgery, Faculty of Medicine, University Malaya Specialist Centre , Kuala Lumpur

Evaluation & the Health Professions

Published online on July 10, 2026

Abstract

Evaluation & the Health Professions, Ahead of Print.
The Ankle-Brachial Index (ABI) is universally mandated for diabetic foot ulcer (DFU) risk stratification, yet its prognostic validity for tissue repair remains structurally inconsistent. To evaluate this diagnostic paradox, we implemented a target trial ...